Cardiac Technology

Definition

Cardiac technology is an area of specialization for allied health professionals. Cardiovascular technologists and technicians assist physicians in the diagnosis and treatment of cardiac (heart) and peripheral vascular (blood vessel) conditions.

Description

Cardiovascular technologists work in the areas of invasive cardiology, echocardiography, and vascular technology. Invasive procedures are those that involve breaking the skin and inserting devices such as catheters and needles into the patient. Cardiovascular technicians perform less technically difficult noninvasive tests such as electrocardiograms and diagnostic ultrasound.

Cardiovascular technologists

Cardiovascular technologists specialize in invasive procedures such as catheterization, or the insertion of a thin tube called a catheter into the patient's blood vessel. For example, the catheter may be inserted in the leg and then extend from the entry point through the blood vessels to the heart. The catheter is used to detect blockage in the vessels that supply blood to the heart. Catheterization is also used to diagnose conditions such as heart defects.

Cardiovascular technologists also assist with balloon angioplasty. Angioplasty is performed as an alternative to surgery to clear blocked heart blood vessels. A catheter is threaded through the blood vessels and when it reaches the blockage, an inflatable balloon at the end of the catheter is expanded, breaking up the blockage.

Cardiac technologists also prepare patients for open-heart surgery and the implanting of pacemakers. Technologists monitor patients during these procedures.

Technologists can also perform skilled noninvasive cardiac examinations using ultrasound equipment. Ultrasound devices send high-frequency sound waves to the patient's heart chambers, valves, and vessels. The sound bounces off the targeted areas and creates echoes. This reflected sound is transformed by ultrasound equipment into images. When performed on the heart, diagnostic ultrasound is called an echocardiogram. It is used to diagnose conditions such as the effects of a heart attack and congenital heart disease. Cardiovascular technologists who perform ultrasound tests on the heart are called cardiac sonographers or echocardiographers. They are skilled in the following noninvasive tests:

• trans-thoracic echo, which sends sound waves into the patient's chest to obtain a diagnostic image
• stress echocardiogram, which uses the trans-thoracic echo test while the patient walks on a treadmill or rides a stationary bicycle
• Doppler echocardiogram, which tracks blood flow in the heart and vessels
• contrast echocardiogram, which is a trans-thoracic supplemented by the use of a contrast solution injected into the patient's veins to produce a view of the interior of the heart
• trans-esophageal echo, where a tiny ultrasound camera is passed through the patient's esophagus to evaluate bypass surgery

Technologists who use ultrasound for the diagnosis of peripheral circulatory conditions are called vascular technologists and vascular sonographers. They perform tests that examine a patient's blood vessels, veins, and arteries in the extremities (arms and legs). Using equipment such as Doppler ultrasound, the technologist monitors blood flow and checks for abnormalities such as the presence of blood clots. (See arterial Doppler ultrasound.)

Cardiovascular technicians

Some noninvasive cardiac diagnostic tests are performed by cardiovascular technicians. One of the most basic tests technicians perform is the electrocardiogram (EKG). The technician places electrodes on the patient's chest, arms, and legs. These electrodes record the electrical activity of the heart as it beats. The resulting chart is interpreted by a cardiologist and is used to help diagnose heart abnormalities. In addition to providing diagnostic information about heart abnormalities, EKGs are performed prior to many surgical procedures and may also be part of a regular physical examination. Cardiovascular technicians specializing in performing EKGs are often called EKG technicians.

With additional training, cardiovascular technicians can become qualified to perform stress tests. Stress tests are also called treadmill tests or exercise electrocardiographs. This procedure is a diagnostic tool to help physicians determine how exercise affects the patient's heart. The test is often used to help determine the cause of chest pain. In a stress test, the technician attaches an electrocardiogram monitor to the patient. The patient's blood pressure before exercise is recorded along with a baseline reading for heart rate. The technician then obtains additional blood pressure and heart rate readings as the patient walks on a treadmill or pedals stationary bicycle.

Cardiovascular technicians can also perform Holter monitoring, a procedure that records a patient's heart rhythm for an extended period of time. Information from Holter monitoring is used to help diagnose conditions such as abnormal heart rhythm. Patients are also monitored after a heart attack or to detect trouble with a pacemaker. With Holter monitoring, patient usually wears a portable electrocardiogram monitor for 24 hours to obtain a record of the heart's response to normal activities. The technician places electrodes on the patient's chest. The patient then wears the portable monitor on a belt for the next 24-48 hours while performing normal daily activities. The resulting information from the EKG monitor is then evaluated by the cardiologist.

Work settings

According the United States Department of Labor Statistics, in 2004 there were about 45,000 cardiovascular technologists and technicians working in the United States. Approximately three-quarters of them were employed in hospitals. Most cardiovascular technologists and technicians work a five-day, forty-hour week with evening and weekend work being common. Employees of hospital catheterization laboratories are likely to work longer hours. Technologists and technicians also work in the offices of cardiologists and other physicians and in medical and diagnostic laboratories. Sonographers are employed in freestanding imaging centers.

In addition to performing diagnostic tests, duties of cardiovascular technologists and technicians may include maintaining equipment and patient files, scheduling appointments, and typing physicians' reports.

Education and training

The American Medical Association has recognized cardiovascular technology as a profession since 1982. Educational guidelines adopted in 1985 for technologists base qualifications on education and experience. Education ranges from on-the-job training for technicians to one to four years of college for technologists. In addition, passage of a credential examination for technologists or technicians demonstrates knowledge of a specialty and provides certification.

Technician training

EKG technicians are usually trained on the job by a cardiologist or EKG supervisor. Training runs from four to six weeks for the basic electrocardiogram test. Education for the stress test and Holter monitoring can last from 18 to 24 months.

As of November 2005, technicians did not have to be licensed, but voluntary credentialing was available. At that time, the credential of Certified Cardiographic Technician was issued after passing an exam given by Cardiovascular Credentialing International (CCI).

College programs

Community colleges offer a range of programs for those seeking to work in cardiovascular technology. Two-year programs lead to an associate of science (AS) degree or a certificate of achievement. Some colleges offer two-year degrees with a specialization in invasive cardiac technology, noninvasive technology, or vascular technology. The certificate reflects courses and training in a specific area of specialization. Some colleges also offer an associate degree in cardiac technology. These programs prepare students to work both as diagnostic sonographers and technicians able to do the EKG and stress tests and Holter monitoring.

After graduating, students can take credentialing examinations. CCI administers tests for Registered Cardiovascular Invasive Specialist, Registered Cardiac Sonographer, and Registered Vascular Specialist. In addition, the American Registry for Diagnostic Medical Sonography administers examinations certify the individual as a Registered Diagnostic Cardiac Sonographer or Registered Vascular Technologist.

Advanced education and training

Several paths can lead to career advancement, depending on the level at which the individual enters the field. For example, an EKG technician can pursue training in stress test and Holter monitoring or study for a two-year AS degree in the specialty of invasive cardiac technology, noninvasive cardiac technology, or vascular technology. Proficiency in more than one specialty also leads to advancement. At a more advanced level, some universities offer four-year cardiovascular technology degrees and some bachelor of science in allied health programs provide internship experience in both catheterization and echocardiography. Allied health workers may also advance to management positions within their professions. Advancement is often based on work experience and/or a college degree in business or a related field.

Future outlook

According to the United States Department of Labor Employment, job opportunities for cardiovascular technologists and technicians are expected to grow by 21-35% through the year 2012. Employment in this area is projected to grow faster than the average rate of job growth nationwide. Rising demand within the field of cardiovascular technology is attributed to the continuing growth of an aging population since as people age, the risk for health problems increases.

Also projected are future advances in diagnostic technology that will decrease the need for invasive procedures. This projected trend is expected to lead to increased employment for echocardiographers and vascular technologists. Furthermore, projections indicate that there will be less need for technicians with only EKG training since the procedure will be performed by other employees such as nurse aides. The employment outlook is brighter for technicians who are trained to give stress tests and do Holter monitoring.

KEY TERMS

Artery— A blood vessel that carries blood away from the heart to the rest of the body.

Blood clot— A solid substance that develops in arteries or veins that can block the flow of blood and have serious health effects.

Blood vessel— A tube in which blood circulates. Arteries, arterioles, capillaries, venules, and veins are blood vessels.

Pacemaker— An implanted electronic device that that stimulates heart muscle contractions.

Vein— A blood vessel that carries blood from a part of the body back toward the heart.

Resources

BOOKS

Kremkau, Frederick, James Eckenhoff, and Leroy Vandam. Diagnostic Ultrasound: Principles and Instruments. Philadelphia: Elsevier Health Sciences, 2005.

Ridgway, Donald P. Introduction to Vascular Scanning: A Guide for the Complete Beginner. Pasadena, CA: Davies Publishing, Inc., 2004.

PERIODICALS

"Aging Baby Boomers, Maturing Technology Will Shock Cardiovascular Care Services." Medical Devices & Surgical Technology Week (April 11, 2004): 105.

ORGANIZATIONS

Alliance of Cardiovascular Professionals. Thalia Landing Offices, Bldg. 2, 4356 Bonney Road, #103, Virginia Beach, VA 23452-1200. (757) 497-1225. http://www.acp-online.org.

American Registry for Diagnostic Medical Sonography. 51 Monroe Street, Plaza East One, Rockville, MD 20850-2400. (800) 541-9754. http://ardms.org

American Society of Echocardiography. 1500 Sunday Dr., Suite 102, Raleigh, NC 27607. (919) 861-5574. http://www.asecho.org.

Cardiovascular Credential International. 1500 Sunday Dr., Suite 102, Raleigh, NC 27607. (800) 326-0268. http://www.cci-online.org.

Society for Vascular Ultrasound. 4601 Presidents Dr., Suite 260, Lanham, MD 20706-4831. (301) 459-7550. http://www.svunet.org.

OTHER

Bureau of Labor Statistics, U.S. Department of Labor. Occupational Outlook Handbook, 2005–06 Edition. "Cardiovascular Technologists and Technicians." November 2005. http://www.bls.gov/oco/ocos.100.htm.